Saturday, May 28, 2011

Anchorage Vacation

It is hard to believe we have already been home in Kodiak 3weeks. We had an amazing time in Anchorage waiting on Caitlyn to make an appearance. Scott followed us up about a week after the girls and I had been there, so we were able to get a feel for the area before he arrived and get some of the shopping out of the way that he wasn't thrilled about going to. After he arrived our weeks were filled with adventures our favorites included hiking and enjoying warmer weather and sunshine.

While exploring we found this wonderful waterfall that rain under the road and the opportunity for some hiking and cooling off in the water, which was VERY cold!!



We also discovered how much fun it was to pan for gold. This mine was a blast to explore and supposedly had quite a bit of gold in the river, although we didn't find any we once again enjoyed playing in the water.



These were the original building for the gold panning. The area was beautiful.


This wasn't at the same area, it was more of a tourist trap but the girls had a blast playing in the water and it sparked our interest in panning.



Panning provided ample opportunities to play in water. Generally it is too cold on Kodiak to enjoy playing with water. In Anchorage however we had several very sunny days in the 70's and at least one day almost hit 80. I think that was the day we were here at the river. Alisha and I got home with a little more sun than I had intended.


Brianna has an odd attraction to the water. Everytime she gets near it she ends up falling in which is generally a little traumatic for her. I don't think I had even finished putting our things down when Scott walked up with a very distraught and wet little girl. She spent the rest of the day on Jaime's back bundled up.


Aside from playing in water we also say a ton of wild life as can be expected in Alaska. This eagle was practicing being the flag pole topper for the Alaska zoo, I'm pretty sure he sat like that for over an hour.





I was very impressed with how active the animals were at the zoo. This polar bear paced infront of us for several minutes then would go to the gate and roll his head. There was also a badger that was running laps in his cage for a good 20mins. The bear cubs played in the pools and threw balls at the fence and wolf pack chased each other in their cage wrestling and howling. It was the best visit I think I've had to a zoo.


Aside from caged animals we also saw a wide range of wild animals. AFter arriving in Homer at midnight Jaime offered to drive to Anchorage for me, she wasn't driving 5mins before I hear this quite, "Oh my goodness, That's a moose!!", I opened my eyes to see a moose's very large rearend pass by my window. At one park we didn't even get out of sight of the car before running in to another moose resting on the path. I also learned that Moose are more dangerous than bears as more people are killed by moose each year than bears, although that is most caused by people hitting them with their cars. Moose with calves however are very dangerous and generally avoided by all.


Other than hiking and animal viewing we also went glacier viewing, hiking and jumping.


While I couldn't do much glacier hiking I enjoyed the view will Scott and Jaime explored. They also taught Alisha how to properly jump over cracks and water.


She had a blast coping Jaime




We also got to experience fresh from the glacier water, which was slightly warm by the time they brought it back to the car to me. I was told it was amazing though.



Yes the black "dirt" is actually ice and very slippery. Scott and Jaime also had a blast jumping.


To end our vacation we treated Jaime to her first King crab dinner. She was then attacked by her crab. However she beat it and from my understanding loved it.

We had too much fun and too many adventures to put into one post but at least these were the hightlights. The best adventure of the trip however came from the little bundle that we got to bring home.

Monday, May 23, 2011

Bri''s Birthday difficulties

So blogger apparently does not like my update on Bri's birthday. I have posted it at least twice and it shows up for a day then dissappears. I finally find it again in my edited posts and all my pictures are messed up.
We had a small party with close friends the weekend after her birthday. THe kids had a blast dressing up like princesses. B was especially cute in her pink ruffles dress. We had a grill out followed by homemade cupcakes. I thought the cupcakes turned out very well however I did need to work on my decorating. The birthday girl also got several wonderful gifts that she has been throughly enjoying ever since. The biggest gift was really a family surprise as the humane society had called earlier that day and asked if we would be interested in taking a puppy that had been returned. So after all the excitement we spent the night enjoying the newest addition to our family, a white mutt that A named Lucy a couple of weeks later.

Friday, May 20, 2011

VBAC vs. Elective Cesearen: Pros and Cons

There is apparently quite a bit of concern regarding mine and Scott's decision to pursue a Vaginal Birth After Cesarean (VBAC). So I would like to shed some light on some of the facts that we have discovered concerning VBAC and Elective C-sections.

The 1995 American College of Obstetricians and Gynecologist (ACOG), which is the leading governing and research body for OB-GYNs recommended "limiting repeat cesarean births to those that were medically necessary. Obstetricians should counsel and encourage women to try to give birth vaginally." It continued to say that vaginal births (after cesarean) "would lead to shorter hospital stays, fewer transfusion, fewer post-partum fevers and a savings of more than four-thousand dollars per birth." It also stated that "not only would this course of action (VBAC) be better for women it would also not cause any greater risk for their babies." They concluded by recommending that "women with 2 or more previous cesareans with no contraindication who want VBAC should not be discouraged from trying for a vaginal birth, that women with large babies should not be automatically exempted from trying a VBAC and that VBACs should not be limited to the largest hospitals."
Between '95 and '98 VBACs were encouraged and done at most hospitals, even the Dr's at our clinic on Kodiak fondly remember doing VBAC on the island. So what changed? Several things, the 2 changes that I find most compelling are the induction rate and societal changes. Prior to '98 little was known about the risk of using induction medication on VBAC patients therefore more VBAC patients were being induced as the use of induction medication also increased. We now know that using induction medication on a VBAC patient increases their risk of uterine rupture. Therefore, dr's willing to attend VBACs today do not consider induction an option until after 6cm dilation and most not even then. Another theory for the change in recommendations is that societal changes in the '90s led to increases in malpractice lawsuits which caused a shift in the recommendations.

The '99 ACOG bulletin withdrawals the recommendation that repeat cesarean section only be done when medically necessary and strongly urges that physicians capable of performing an emergency C-section be "immediately available". Since most hospitals do not have the capability to have round the clock staff they have developed policies that do not allow women to have VBAC's at their hospital. Some smaller hospitals however interpret this recommendation to allow VBAC by having staff on call so that the decision to incision time is 30mins just as they would in the case of a 1st time pregnancy in need of an emergency section. It is my feeling that any hospital that cannot offer emergency surgery to laboring VBAC patients is therefore unable to provide any other form of emergency surgery, as the decision to incision time would also be approximately 30min. The ACOG bulletin also does not provide research supporting their change in policy and since it is my understanding that the uterine rupture rate has not significantly changed it is understandable how people jump to the conclusion that the changes were made not for the benefit of the patient but for the benefit of the Drs. due to increases in malpractice suits. A few of the Drs I have talked to have stated that they feel another shift is coming and they are hopeful that ACOG will once again add in recommendations for allowing multiply cesarean VBACs. For the most recent ACOG recommendation you can visit consensus.nih.gov/2010/vbac.htm

Here is a pros and cons list concerning VBACs:
PROS:
-VBAC is safe (the consent form that must be signed for the Dr and Hospital clearly states that the patient must be made aware that VBAC is safer than elective C-section, no consent form or information form is given stating the risk of elective C-section).
-Elective repeat cesarean poses greater risks to the mother's life and health than does vaginal birth. It poses hazards to the baby as well, especially with succeeding pregnancies and more than one cesarean.
- Most women, including women whose prior cesarean was for lack of progress or who are believed to be carrying a big baby, will birth vaginally if allowed to labor.
CONS:
- While the healed uterine scar is tough it is widely excepted that a form of uterine rupture (symptomatic scar separation) will occur in 1% of VBAC patient that have had 1 prior c-section, it is my understanding that this type of separation occurs most commonly in the first couple hours of labor. Another form of uterine rupture (spontaneous scar separation) is the most common type of rupture and occurs most likely between 36 and 39 weeks, I am not sure at what percent this form of rupture occurs while I have asked several Drs they have not been able to give me an answer other than the 1% mentioned above. Also, while they quote the same percentage of risk they do not ask the patient to take any special precautions such as limiting activities or bed rest, since it is unknown what causes it. Uterine rupture means that the scar will open up enough for the umbilical cord or the baby to pass through the opening or for bleeding to occur (if left unattended or not caught fast enough this may lead to the death of the mother or baby) However, when a c-section is done promptly few babies and even fewer moms will be injured.
-The perinatal mortality rate (deaths around the time of birth) in 29 studies have found that 3 out of 10,000 deaths occur for both VBAC labors and planned cesareans.

Pros and Cons for Elective Cesarean
Pros:
Since there is no labor, there is no chance of symptomatic scar separation, at least not during labor, prelabor cesareans have lower infection and other complication rates than cesareans done in labor.
Cons:
Compared with vaginal birth, c-section substantially increases the risk of infection, injury to other organs, hemorrhage, and anesthesia complications. The complications, in turn, increase the risk of prolonged hospitalization, hysterectomy and maternal death. Repeat c-sections are more technically difficult to perform because of scar tissue. For this reason, injury to other organs is more common, Scar tissue formation can cause chronic pain and bowel problems. Elective cesarean also increases the baby's risk for poor condition at birth, breathing difficulties and jaundice. Each successive cesarean greatly increases the risk of developing placenta previa and/or placenta accreta in subsequent pregnancies. Both of these complications pose life-threatening risks to mother and baby. Cesareans also increase the odds of infertility and ectopic pregnancy, another life-threatening danger, in subsequent pregnancies. Women with multiple prior cesareans have a slightly increased risk of symptomatic scar separation during VBAC.

Closing note: I am not anti-Cesarean. Despite how it sounds I am completely open to allowing the Drs to perform a c-section if it becomes medically necessary. Since I am considered a higher risk I will be under greater supervision and monitoring so that should a c-section need to be done it will be done at the 1st signs of possible danger. However, as I have stated many times in this post all the research agrees that a VBAC is safer than a repeat elective cesarean.

Most of my information has come from the several Drs we have spoken with, Guide to Childbirth by Ina May and The Thinking Woman's Guide to a Better Birth by Henci Goer as well as the NIH website and ACOG VBAC statements.